Why Ethics Matters!

In my second year at medical school we were given a series of ethics lectures. These were delivered by a variety of academics, many of whom were extremely eminent in their field. However, despite this and (probably more importantly) the exam at the end of the course, most of my colleagues couldn't see why the subject might be relevant to their future practice and almost no-one turned up.

Four or five years down the line, now I've started working, I sense there's even more reluctance to think about ethical issues. Within the NHS there seems to be an endemic culture where many of my colleagues get on with their day to day job, almost in a little bubble, and don't stop to challenge or even reflect on the problems facing their profession. The reasons for this are legion, and although ethics forms only a small part of the difficulties we face as medics, recent events have demonstrated how crucial it is that we pause, reflect and challenge this apathy.

Even if doctors aren't interested in ethical problems, the public certainly are, and - thanks largely to extensive media coverage - numerous medico-legal cases have come to prominence in recent years. Consider for example, Diane Pretty, the motor neurone sufferer who asked the courts to permit her husband to help her commit suicide (2002); the parents of the extremely sick premature baby Charlotte Wyatt who wanted her kept alive at all costs (2004); and Natallie Evans, who went to the European courts seeking the right to use her frozen embryos for IVF after her ex-partner had withdrawn his consent (2004). More recently, in May 2006 Lord Joffe's Assisted Dying for the Terminally Ill Bill was extensively debated (and defeated) in the House of Lords, amid huge public controversy.

Bioethics without doctors?

Bioethics, the area of study that looks at complex healthcare dilemmas, first emerged in the United States in the 1970s. This was for two main reasons: 1) in response to a huge increase in the availability of technology in medicine, and questions about how or even whether it should be used, and 2) in the light of this, to open up the medical profession to wider public scrutiny and accountability. Previously, whatever the doctor said went, and the patient had little say in the matter. However, times thankfully changed and doctors began to realise the importance of involving their patients in decision-making.

Things have gone to the other extreme though and, over the past 30 years, doctors seem to have been almost completely pushed out of academic ethical discussions, in favour of philosophers, lawyers and theologians. To me this makes little sense: it is doctors who have to use the technologies in question, and at the same time form a working partnership with the patient.

Bioethics without Christians?

At the same time as doctors have been pushed out of ethical debate, there has been a rather more concerted effort to push religious perspectives - particularly those of Christians - out of the arena as well. This is for many reasons, but reflects well the increasing antipathy towards our faith in society, and it's perhaps never been more important for Christian medics to become actively involved in ethical debate.

Society has little time for religion as a source of ethical norms. However, in his important book Matters of Life and Death (still the single most useful text on Christian bioethics), Professor John Wyatt argues that we must defend a Christian point of view for three reasons: firstly, because it is true - the Christian worldview fits with reality, the way the world is made! Secondly, it also works and leads to beneficial consequences for the whole community. Finally, our perspective as Christians about what is right and wrong, more often than not fits with the basic intuitions of the human heart.[1]

Central to the Christian worldview is the emphasis on the importance of every individual, or all human life. When humans were created in Genesis 1, they were the pinnacle of creation. We were also set apart from all other creatures in that we are the only ones created in the image of God himself.

Genesis 1:26,27 says, 'so God created man in his own image, in the image of God he created them.' Each and every human life therefore bears this image, and the consequences of this are enormous and far reaching. The value of all human life is infinite because we are all individually known and called into being by God. Similarly, the Bible expressly forbids the killing of humans, simply because we are made in the image of God.[2] This concept of each and every person not only reflecting God's image but also being valuable enough to our creator that he was prepared to send his son to die for us, lies at the heart of Christian medical ethics.

Taking, making and faking life

The cases mentioned earlier – Diane Pretty, Charlotte Wyatt, and Natallie Evans – illustrate the breadth of issues currently under debate. Each topic, and indeed each case, deserves a whole article in its own right, but it's helpful to review briefly what's going on. We can loosely group the ethical issues we face today into three 'schools': taking life, making life, and faking life.

In the latter part of the 20th century, when and whether it was right to take or end life was one of the principal ethical problems that doctors had to address. Legislation was passed in 1967 permitting abortion in this country. Now abortions are seen as very much an accepted part of the National Health Service and over 180,000 terminations are carried out each year in England and Wales alone.[3] However, there are still big concerns about this amongst Christian doctors, because of the value of human life and the Bible's express command not to kill. The big question in all this is when human life actually begins, and if the embryo in the womb is not yet alive is it okay to destroy it?[4]

The other issue in the 'taking life' camp is euthanasia. This is an enormous issue at the moment, and indeed some argue that it could change the face of healthcare. According to the original Greek roots of the word, eu-thanasia literally means 'a good death'. However, in contemporary medical language, it has come to mean 'the intentional killing of a person whose life is felt to be not worth living'. The doctor prescribes and then administers a lethal dose of medication with the intention of killing the patient. The other buzz word is 'physician assisted suicide' – the doctor prescribes the lethal drug, but the person administers it to themselves, ending their own life. Lord Joffe's bill, which could have seen assisted suicide legalised here in the UK, was soundly defeated on 12 May by 148 votes to 100, after long debates in the House of Lords. However, this issue will not now go away.

The problems of 'making life' principally involve those technologies such as in vitro fertilisation, where again we have to ask - amongst other things – is embryonic human life really life at all, and if so, does this really matter anyway? Should we really experiment on spare embryos if they're not thought to be alive, then flush them down the sink when they're no longer needed? More recently other technologies have come to prominence as well such as cloning but, although successful attempts have been made to clone a variety of animals, such as Dolly the Sheep, no one has yet successfully managed to clone a human being and this – rightly – remains illegal in most parts of the world.

Finally, faking life. This is mostly the stuff of science fiction at the moment but there are scientists seeking not only to replicate themselves by cloning, for example, but radically alter human beings as we know them in order to overcome all our present human limitations. One way of doing this would be to merge man and machines and create 'cyborgs'. Less far fetched, but similarly trying to engineer 'better' human beings are anti-ageing treatments and some forms of cosmetic surgery. God created us in his image, and our desire to 'improve' humanity to our own standards raises questions about our attitude towards the way God created us.[5]

Bioethics needs Christians

Christian medics are in a unique position to speak out on many of these issues: we can put forward not just a biblical perspective that reflects the way the world works, but also an informed medical viewpoint that takes into account the problem and the technology, along with the human beings at the centre. One of the greatest challenges facing bioethicists is relating the academic debate to the patient, and again our input as medics is crucial. In my final year at medical school, I undertook a split elective. For half the time I was completing research for a bioethics degree, looking at human enhancement technologies in the light of biblical anthropology. For the rest of the time, I was based in a critical care environment where questions arose in my mind on a regular basis about the use of technology at the limits of medicine and how this applied to the patient being subjected to it. One humbling – and unexpected – benefit of the whole elective was the realisation that the debates about ethics and medicine (however far-fetched) could, and should, never be simply academic exercises. The patients and relatives in that unit didn't care about slippery slopes, autonomy or any of the other 'four principles', nor for that matter about the application of Old Testament scripture and the interpretation of early Christian writings.

Your fellow students are starting to think about these issues in a way they won't again in the future once they become doctors and, in the light of the Joffe bill and all the debate surrounding that, there's a real interest in ethics amongst the public right now as the extensive media coverage demonstrated. Similarly, as much as it sounds like a cliché, you have more time and resources available to help you investigate and think about ethical issues than you will at any other time. Use that time well to formulate your thoughts and ground yourself in the theory then when you find yourself facing the problem in 'real life,' you will be better equipped to respond articulately and biblically.

Even as a student, your friends and relatives will respect your opinion as a medic. I can think of several situations where non-Christian friends collared me, knowing my interest in ethics, and asked for my opinion on, for example, IVF. Although this is a huge topic, which can't easily be covered in a brief conversation, such discussions have presented me with fantastic opportunities to talk about Christian principles and my faith more generally. Beware however that this sort of question may reflect a huge personal struggle or pain, as I discovered with one friend, so must be handled with sensitivity – another lesson in taking ethics beyond academic debate.

As Christians, we have a responsibility to be looking forward, proclaiming and predicting according to God's Word, almost in the manner of the Old Testament prophets, both to our friends and more widely in the public arena, communicating clearly the potential consequences of developments in medicine. The 18th century MP Edmund Burke is often quoted as saying 'all that is necessary for the triumph of evil is that good men do nothing,' and this is certainly the case.

However, even more strongly than Edmund Burke, and perhaps more soberingly, the New Testament writer James says 'Anyone, then, who knows the good he ought to do and doesn't do it, sins.' (Jas 4:17) With the benefit of hindsight, we can look back to the 1960s when the legalisation of abortion was being debated and say that Christians at the time didn't do enough at the time to stop it. Clearly it would have been difficult for them to predict all the consequences of the bill and subsequent developments that we can see now, but will our children and grandchildren look back at us in 50 years time and say that we didn't do enough to stop the legalisation of euthanasia?

Perhaps of even greater importance and urgency though, many ethical issues (such as euthanasia and our increasingly pro-death culture) simply reflect a much greater problem – that society has rejected Christian faith and values. As well as seeking to influence the medical profession, we also have a responsibility to convey the wider hope we have as Christians and this is something the world desperately needs to hear: by God's grace, we know that our present sufferings are limited, and that we are ultimately assured of eternal life, as well as freedom from pain and the burden of a frail body.